AB0493 FACTORS ASSOCIATED WITH SUICIDAL IDEATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME PATIENTS
Authors: A. Borisova, T. Lisitsyna, D. Veltishchev, T. Reshetnyak, O. Seravina, O. Kovalevskaya, F. Cheldieva
Journal: Annals of the Rheumatic Diseases (2022)

Background Suicidal ideations in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) patients are associated with stress related depressive and anxiety disorders and can lead to higher mortality rates. Objectives To describe the rates and potential causes of suicidal ideations in SLE and APS patients. Methods 159 patients (62 with SLE, 49 with SLE and secondary APS, 48 with primary APS (PAPS)), mostly women (120 (75,5%)), were consecutively enrolled in the study. The mean (M±SD) age was 37,5±12,2 years. SLE activity was measured by SLEDAI. Suicidal ideations and mental disorders were detected by psychiatrist in semi-structured interview. The severity of mental disorders was measured with MADRS, HADS, PHQ9, PSS10, and quality of life with EQ-5D, LupusQoL. Results The majority of patients had mental disorders (149 (93.7%)) with a predominance of anxiety and depressive spectrum (143 (89.9%)). Anxiety and depressive disorders in remission were diagnosed in 7 (4.40%) patients. Suicidal ideations in the past were revealed in 20 (12,6%) patients: in SLE - 9 (14,5%), SLE + APS - 8 (16,3%), PAPS - 3 (6,25%); suicidal attempt – in 1 (0,63%) patient with SLE + APS; autoaggressive behavior – in 11 (6,92%) patients (mainly presented as discontinuation of treatment in 10 (6,29%) patients): 6 (9,68%) - SLE, 4 (8,16%) - SLE + APS, 1 (2,08%) - PAPS. Current suicidal ideations were found in 16 (10,1%) patients: SLE - 5 (8,06%), SLE + APS - 5 (10,2%), PAPS - 6 (12,5%). The patients with suicidal ideations had higher depression (according to MADRS, HADS, PHQ-9) and anxiety (according to HADS) severity, they also presented with higher rates of stress perception (PSS-10) and poorer life quality (EQ-5D, LupusQol). The APS duration was significantly longer in patients with suicidal ideations; no differences in activity, severity and duration of SLE or steroid therapy were found, but SLE patients with current suicidal ideations compared to patients without them were 2 times more likely to receive rituximab (Table 1). Table 1. Description of patients with/without suicidal ideations. Characteristic, Me [25%; 75%] M±SD With current suicidal ideations (n=16) Without current suicidal ideations (n=143) p n % n % SLE 5 31,3 57 40,2 n/s SLE+APS 5 31,3 44 30,9 n/s APS 6 37,4 41 28,9 n/s SLE duration, months 156,0 [132,0; 216,0] 84,0 [24,0; 68,0] n/s APS duration, months 228,0 [204,0; 348,0] 120,0 [48,0; 180,0] 0,001 MADRS 27,0 [14,5; 31,5] 13,0 [8,0; 18,0] 0,0001 HAM-A 18,5 [10,5; 25,5] 15,0 [10,0; 21,0] n/s HADS: -depression 7,0 [3,0; 9,0] 3,0 [1,0; 6,0] 0,009 -anxiety 9,0 [5,0; 14,0] 6,0 [3,0; 9,0] 0,04 PHQ-9 12,0 [8,0; 15,0] 6,0 [3,0; 12,0] 0,02 PSS-10 32,7±8,73 27,6±6,50 0,006 EQ-5D 0,56±0,29 0,72±0,22 0,009 Lupus Qol 113,7±24,9 132,0±25,8 0,02 Methylprednisolone intake: -Current dose, mg/day 10,0 [0; 22,5] 10,0 [5,0; 15,0] n/s -Сumulative dose, g 16,9 [0,9; 61,2] 7,2 [0; 28,9] n/s Rituximab treatment 5 31,2 26 18,2 n/s Conclusion Suicidal ideations in SLE/ APS patients are mainly caused by anxiety-depressive spectrum disorders provoked by stress factors, no associations with the duration, activity and manifestations of the rheumatic diseases were found. Timely identification and therapy of depressive and anxiety spectrum disorders can prevent suicidal ideations and possible poor outcomes. Disclosure of Interests None declared